10040072 CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10040072
BUILDING ADDRESS: 10037 SCENIC BLVD
244 GREAT MALL PKWY DATE ISSUED:04/12/2010
OWNER'S NAME: DAVID NILSSON PHONE NO:(408)934-0730
F.VER'S PHONE: 4082520561
MILPITAS,CA 92683
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I— PLUMB f
Z D Lie.# -76 ✓ �� 1 MECH rRESIDENTIAL COMMERCIAL
/) o
�� Date 1 2JOB DESCRIPTION:REMOVE&REPLACEMENT FURNACE IN SAME
m that I am licensed under the provisions of Chapter 9 LOCATION
with Section 7000)of Division 3 of the Business&Professions
t my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Valuation:$5000
1 have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area:
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:35709056.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by:/ Date:
9.18.
Signature
Date Ira
RE-ROOFS.
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation, Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous
5 of the
I have and will maintain a Certificate of Consent to self insure for Worker's California Health&Safety Code,aSections 25505525533,Chapter 9
and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall
Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's g lfo
aking this certificate of exemption,I O er or autho 'zed agent'
Compensation laws of California. If,after mDate:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
il—the above mentioned property for inspection purposes.(We)agree to save Lender's Address
mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18. Licensed Professional
Date Lit �'�
Signature i �.
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
7 ITEMS OF 7 COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35709056 . 00
DATE ISSUED. • • • • . . : 04/12/2010
RECEIPT # . . . . . . . . .
55
REFERENCE ID # 10040072
SITE ADDRESS 10037 SCENIC BLVD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DAVID NILSSON
ADDRESS 10037 SCENIC BLVD
CITY/STATE/ZIP CUPERTINO CA, CA 95014-2724
RECEIVED FROM APLUS HEATING& AIR-
CONTRACTOR ADAM P. PHAM LIC # 31293
COMPANY . . . . . . . . . . : A PLUS HEATING & A/C
ADDRESS 244 GREAT MALL PKWY
CITY/STATE/ZIP MILP T S, CA
A3092683
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC - NEW-BAL-
__ -------- 1 . 00
---------
--------- 1 . 00 0 .00 1 . 00 0 . 0
1BCBSC VALUATION 5, 000 .00 0 .50 0 . 00 0 .50 0 . 00
1BSEISMICR VALUATION 5, 000 .00 42 . 00. 00 0 . 00
1 42 . 00 0 .00
1EPERMITFE FLAT RATE 42 . 00 0 . 00
1MPERMITFE FLAT RATE 1.00 42 . 00 0 . 00 63 . 00 0 . 00
1 . 00 63 . 00 0 .00
1MRRAA UNITS 42 . 00 0 . 00
1PPERMITFE FLAT RATE 1.00 42 . 00 0 . 00 0 . 00
1 . 00 42 . 00 0 .00 42 . 00
1TRAVDOC FLAT RATE ______ ---------- ----------
232 . 50
0 .00 232 . 50 0 . 00
TOTAL PERMIT
METHOD OF PAYMENT
AMOUNT REFERENCE NUMBER
CHECK 232 .50 #1271
---------------
TOTAL RECEIPT 232 . 50
VOICE ID DESCRIPTION
VOICE ID DESCRIPTION
---------------------------
-- - 507 FINAL PLUMBING
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
CITY OF i o c�H 0
CITY OF CUPERTINO
2FURNACE/AC
cuPERYW
$ PERMIT APPLICATION FORM
Date: 04/09/2010
APN# O5
Building Address: 10037 Scenic Blvd .,Cupertino,CA 95014
Phone#: 408-252-0561
Owner's Name: David Nilson
Phone#: 408-934-0730
Contractor: Aplus Heating &AC, Inc.
Fax #: 408-934-0734
Cupertino Business License #:
Contractor License#: 763154 31293
Phone#: 408-934-0730
Contact:
David Barragan Fax#: 408-934-0734
Building Permit Info:
Elect Plumb Mech
Residential I x I Commercial ❑
t
!!!!:Remove
and replacement Furnace in the same location
For Residential Installations: 2°d floor ❑
Attic 0 1St floor ❑
Adhere to minimum setback requirement ❑
FReplace
ercial Installations:
nt same weight ❑ Additional weight(structural calcs) ❑
Calculations required for new installation ❑
lation Plannin A roval Required El Constructi n(Usage Class):
Cost of Project: Type of
$5,000.00
Strapped ❑ On Platform ❑ Bonded❑ New Location ❑ Replacement 0
Project Size: Ex ress ❑ Standard Large ❑ Mal or❑
Valuation: -::!
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable,include in plan set& the sheet index.
Revised 01/07/09
CITY OF CUPERTINO
FURNACE/AC
CITY°FFEE SCHEDULE
CUPEkTINO
Quantity Fee ID Fee Description Fee Permit Type
Grou
1 MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ incl in an ap 1 permit. FURN/AC
FURNACE
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
/ 1BSEISMICR Residential Seismic B
I
1MECPLNCK Mechanical Plan Check M
I
1MFR=<100 Furnace Sy
<=100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
IEPERMITFEE Electric Permit Fee E
I . . M
1MPERMITFEE Mechanical Permit Fee
1PPERMITFEE Plumbing Permit
P
1TRAVDOC Travel Documentation B
l B
1BUSLIC Business License
M.Indoor Air Quality and Finishes
1.Use LowNo-VOC Paint 1 IADJHealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use LDwND VOC Adhesives 31AQ/Hsalth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts Y--Yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y--yes0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal al- or MDF _ 4 IAQ/Health pts = es-- 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
o
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts Y=yes 0
2.Use Sapiclly Renewa,We Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 i t
Total Points Available: 1 1401 130E- 57
Total Points Project Received: 01 O=
Li
G:datalpropslgreenbuiidingguidelines/ramodelerslgreenpointsfina1212.04proteMed.xls
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: C�,LVn PERMIT#
OWNER'S NAME: qv Ca l 54' PHONE# �fD7� 31 Z
GENERAL CONTRACTOR: "�J S BUSINESS LICENSE# S
ADDRESS: '2 Z" -rec� G��\ "kw CITY/ZIPCODE: rn�� b 7s
Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
L BE SCEULEUNTIL THE
NO BUILDING FINAL OR FINAL OCCUPANCY INS HAVE OBTAINED ACIY OCUPERTINO INSPECTION(S)
ORS
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS
BUSINESS LICENSE. 1.4
I am not using any subcontractors: Si ature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR
BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
Owner/Contractor Signature